Agenda item

Ivor Duffy (Director of Assurance and Delivery, NHS England), Bill Millar (Interim Director, Urgent Care and Primary Care, East Kent CCGs) and Mark Atkinson (Head of Acute Commissioning, West Kent CCG) were in attendance.

(1)       The Chair welcomed the guests to the Committee and noted that the North Kent CCGs had been unable to provide a representative. Mr Duffy began by stating that winter had been challenging. There had been a severe outbreak of seasonal influenza which had an unusual strain. He highlighted a successful vaccination scheme at East Kent Hospitals University NHS Foundation Trust which had donated a tetanus vaccination to UNICEF for every staff member who had the flu jab; as a result, the Trust had one of the highest flu jab uptakes in the country.

(2)       He stated that a number of reviews had been undertaken to pull together the key learning which included a greater need for consistency around escalation and working together as a system through the STP. He noted that whilst NHS England had historically been responsible for coordinating the system, local systems had now taken on the leadership role and NHS England was providing more of an advice and support role. He stated that further work to improve communication with the public on accessing primary and urgent care services was required.

(3)       Mr Millar explained that the winter and Easter periods had been challenging in East Kent with A&E performance at 60 – 70% against a standard of 95%. There was also a system focus to address discharge; EKHUFT worked with SECAmb to put in place mitigating actions for handover delays and additional funding from NHS England had been received to work with the voluntary sector to support discharge. He noted that an improvement plan had been submitted to NHS England which described the collective action being undertaken.

(4)       Mr Atkinson stated that the position in West Kent was slightly better as there were only two hospitals and flow could be moved between the sites. He highlighted a number of initiatives which had been implemented using winter monies including primary care centres at the hospital sites being managed by MTW, additional medical team to support delayed transfers of care and the introduction of a Home First scheme by a private provider to support patients in their own homes. He recognised that there needed to be better engagement with primary care; he reported that the relationship and collaboration between health and social care had developed over the winter.

(5)       The Chair enquired about additional resources for primary care. Mr Duffy explained that there had been a number of initiatives had been implemented which included GP triaging at A&E departments and extended primary care opening hours. He recognised that more work was required to tie-in these resources with the wider system and effectively communicate with the public as there had been some underused capacity. He stated that the growing demand for the 111 service was being addressed as part of the Integrated Urgent Care Service Procurement. Further work was also being undertaken to identify where the peak periods for 111 would fall  as part of planning; the 2017/2018 peak came sooner than anticipated which had a knock-on effect to other services.

(6)       Members enquired about elderly fallers, staff vaccinations and the strain of flu and the effectiveness of the vaccination. Mr Duffy reported that hospitals planned for increased falls and fractures such as the procurement of additional orthopaedic surgeons at EKHUFT for anticipated periods of high demand. Mr Duffy explained that staff vaccination was personal choice and not compulsory. He noted the work done with care homes to ensure that staff knew the benefits to them and the wider system of having the vaccination. He committed to sharing with the Committee, the percentage of staff in Kent & Medway who had the flu vaccination and the learning from the influenza debrief. Dr Duggal explained that the strain for the flu vaccine was determined a year in advance, based on global evidence, by the World Health Organisation, Centre for Disease Control and UK Health Authority. She noted that a new strain arose whilst  the 2017/18’s vaccination was in production and it was therefore not able to be included in the vaccine.

(7)       RESOLVED that the report be noted and NHS England and the Kent & Medway STP be requested to provide an update about preparations for 2018/19 winter to the Committee at its September meeting.